Last night Cerner managed a major upgrade to its Community Works clients. As our brave employees huddled over their computers, validating the upgrade at 1:30 a.m. this morning, it occurred to me that we are a lucky crew to have selected the ASP model for our EHR solution.

Yes, sharing the domain can be frustrating when we request a change that impacts other clients in the shared space … but it is also nice when other clients have suggestions that benefit us.

Yes, it would be nice to have an IT department onsite to handle all this folderol and hoopla instead of our registration clerk, lab manager, financial manager and night nurse … but then we would have to recruit, pay and keep happy a highly skilled employee in a very rural area of the country.

Yes, frustration levels increase when changes are implemented in the domain … but then again, our software is up to date on Cerner’s dime, all the time. We don’t have to keep current on patches and updates to the system like we would if we had the software installed on our own servers.

We recently participated in our 21st reference event since going live January 2011. These events can be phone calls, emails or site visits from other health care organizations considering Cerner as their EHR partner. We answer questions, connect their employees with peer employees at Syringa, and share the good and the frustrating with them.

Syringa’s employees focus on providing quality patient care and service, so it is sometimes hard to see how far we have come on this journey. With HIMSS 6 and Stage 1 Meaningful Use Attestation under our belts, we are a model implementation; but now we have the basics under our belt, we strive for ways to better serve our patients.

Dare I mention our old friend, Alice in Through the Looking Glass? She spent some time with the White Queen – the Queen who practiced believing as many as six impossible things before breakfast. This Queen had a fantastic memory, one which roamed toward the past, but also into the future. She could remember things that had not happened yet, and found Alice’s memory “a poor sort that only works backward.”

If backward memory is experience, then forward memory is anticipation. We must anticipate what our patient’s need, the health care sector will require of us, and the economic factors that affect the bottom line.

This is where we are now. We have plenty of backward memory. It is time to move into forward memory mode: anticipating improved patient outcomes by making use of our EHR experience and information.

The very last scene of Alice’s Adventures in Wonderland finds Alice at the trial of the Knave of Hearts, who stole some tarts. Like all her adventures, this one proved confusing: The verdict was given before the evidence, and the witnesses received sentences of, “Off with his head!”

But in one still moment of clarity in the convoluted courtroom scene, the King of Hearts, presiding over the action, told a witness, “Begin at the beginning, and go on till you come to the end; then stop.”

The next four weeks until we Go Live with Cerner will be a rush of a million last minute details: competency exams, scenario testing, workflow assessment, equipment upgrades, and training. This amazing choreography of changing the way we document patient care can confuse and frustrate, resulting in barking and snarking.

However, once we get to the final performance of this complex dance – after hours of long practice and sore muscles – the astonishing beauty of all the parts coming together in perfect harmony is breathtaking. Or, so I believe because this is one of the things I practice every day before breakfast! (Click here)

In the next four weeks we must, over and over again, “begin at the beginning, and go on till you come to the end,” as we practice, plan, and develop strategies for this new way of supporting the health of Idaho County.

We had to extend our Go Live date again to accommodate Cerner’s need to complete our final build. We are looking at January 3, 2011 for the new date.

It seems an appropriate time to relate our EHR adventures in this matter to Chapter Two of Alice’s Adventures in Wonderland, entitled, “The Pool of Tears.”

You remember the scene: Alice landed in Wonderland, but couldn’t follow the White Rabbit through the door into the garden because she was too big. She discovered a bottle labeled DRINK ME, and when she did, she shrank. Unfortunately, she left the key to the garden door up on the tabletop, and, being short, could not reach it. When she found a box of cake labeled EAT ME, she followed the directions exactly, growing almost instantly to nine feet tall.

This change brought Alice to tears. And when you are nine feet tall you shed gallons of tears, enough to create a small ocean. When Alice eventually shrank down again, she nearly drowned in her own pool of salty tears.

When I first read this I wanted to relate the pool of tears to wallowing in self-pity. You know, the “I’m tired of this project, the delays, the disappointments, the change, the hard work, the stress, the ….” ad nauseam.

Then I began to understand that Alice didn’t relate to the pool as if it were a horror. To her, the pool was just a fact, not born of desperation and self-pity, but born of adventure and an eager anticipation of reaching the door to the garden. The tears were the physical manifestation of her own awareness of the changes she had experienced. She jumped in, gathered some friends to help, and swam across to her goal.

So this pool of tears I find myself in right now isn’t about the ad nauseam above, or the new Go Live date. Rather it is the physical proof that Syringa is changing. We can’t quite get to the goal yet because the friends we need to help us across are still working their way through the pool. But we are in the water, and we are looking for them.

This pool of change is really the last conscious effort we have to make to cross to the door that opens into the wonderland of improved healthcare for everyone in Idaho County. Ready for a swim?

Our Cerner implementation team is calling this week’s visit a “system review.” They hope to assess where they are with building the system and develop a plan to move us forward to a successful Go Live in December.

As the Project Manager for Syringa, I feel a keen responsibility for this delay. If only I had only listened to what the White Rabbit was actually saying in Alice’s Adventures in Wonderland before Alice followed him down the rabbit hole.

Remember what he was muttering? And how remarkable Alice found it?

“Oh, dear! Oh, dear! I shall be too late!”

If only I had only understood how that phrase would play out over time! If only I had heeded the warning that the Cerner White Rabbit was running late! Even after landing with both feet into Wonderland, the Rabbit continued to worry about the time, saying “Oh, my ears and whiskers, how late it’s getting!”

If only …

In all fairness, we’ve been busy with many other adventures endemic to implementing EHR. We have gathered documents, analyzed processes and procedures, conversed with one another, purchased equipment, determined rules, learned new syntax, trained ourselves and staff, and welcomed change into the organization.

So, while we followed a habitually late rabbit into EHR implementation, we are a better health care facility. And by the time we Go Live in December, we will be even more prepared for the new technology. Our system will be more robust, our employees better trained, our patients in the best possible hands.